<form action="/register" method="post">
	Username : <br/>
	<input type="text" name="user_login"/><br/>
	Password : <br/>
	<input type="password" name="pwd_login"/> <br/>
	Domain : <br/>
	<input type="text" name="domain"/><br/>
	Username post domain : <br/>
	<input type="text" name="username"/><br/>
	Password post domain : <br/>
	<input type="password" name="password"/><br/>
	<input type="submit"/>
</form>